August 31, 2009
Retail medical clinics located in pharmacies and other stores can provide care for routine illnesses at a lower cost and similar quality as offered in physician offices, urgent care centers or emergency departments, according to a new RAND Corporation study.
The study, the first to assess the quality of care provided in retail medical clinics in the United States, compared the care provided in different settings for patients with middle ear infections, sore throats and urinary tract infections. Researchers found no difference in the quality offered to patients visiting retail clinics, physician offices and urgent care centers, but retail clinics did slightly better than hospital emergency departments.
The American Academy of Pediatrics and other physician groups have raised concerns about the quality of care provided at retail clinics, including whether the clinics might be likely to overprescribe antibiotics and limit preventive care by disrupting normal doctor-patient interactions. The RAND study found no evidence to support the concerns. The study is published in the Sept. 1 edition of the Annals of Internal Medicine.
"These findings provide more evidence that retail clinics are an innovative new way of delivering health care," said lead author Dr. Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine and a researcher at RAND, a nonprofit research organization. "Retail clinics are more convenient for patients, less costly and provide care that is of equal quality as received in other medical settings."
In a second study also published in the Annals of Internal Medicine, RAND researchers found that there are almost 1,000 clinics in the United States and that about one-third of urban Americans now live within a 10-minute drive of a retail medical clinic, further evidence the clinics can provide care to a growing number of Americans.
Retail medical clinics are walk-up medical providers typically located in drug stores and other retail chain stores such as Target and Wal-Mart rather than in medical facilities. Care most often is provided by nurse practitioners rather than by physicians.
In the study of quality of care, researchers examined the experiences of 2,100 patients treated at retail clinics in Minnesota during 2005 and 2006 for middle ear infections, sore throats or urinary tract infections. Those patients were compared to similar patients treated for the same ailments in physician offices, urgent care centers or hospital emergency departments.
The quality of medical care was judged using 14 indicators of quality and whether patients received seven preventive care services during the initial visit or over the subsequent three months. Quality scores for retail clinics were equal to or higher than those in other care settings, with the exception that a smaller proportion of high-risk patients received a urine culture at retail clinics.
The study found that the costs of treating the acute illnesses at retail clinics were 30 percent to 40 percent lower than in physician offices or urgent care centers and 80 percent lower than in emergency departments. The differences were primarily caused by lower payments for professional services and lower rates of laboratory testing.
Researchers caution that their findings may not adequately represent the care provided at all retail medical clinics. The study was conducted only in Minnesota, among insured patients, and among patients of only one retail clinic chain. In addition, the findings could be influenced by unmeasured factors such as whether less-sick patients, who need less-intensive services, seek out care at retail clinics rather than going to one of the other medical providers.
"We need to continue to examine retail medical clinics as they grow in number, but the results we have seen thus far suggest they provide high-quality care in a convenient and cost-effective fashion," Mehrotra said.
The second study also found that more enterprises are beginning to operate retail medical clinics. While three for-profit companies including industry leader MinuteClinic operate about 70 percent of the nation's retail medical clinics, an increasing number of hospital chains and physician groups are becoming involved.
In addition, new types of partnerships between existing providers and retail clinics have developed. Retailer Wal-Mart has partnered with local hospitals to co-brand clinics in its stores, and MinuteClinic and the Cleveland Clinic recently announced a partnership to run nine clinics together and to integrate electronic medical records.
Researchers also found that while retail clinics initially did not accept insurance, now most accept both private insurance and Medicare, and more than half also accept some form of Medicaid.
Funding for both studies was provided by the California HealthCare Foundation. Other authors of the studies are Rena Rudavsky, Hangsheng Liu, John L. Adams, Margaret C. Wang, Dr. Craig E. Pollack and Elizabeth A. McGlynn of RAND; Judith R. Lave of the University of Pittsburgh; and Dr. N. Marcus Thygeson and Dr. Leif I. Solberg of HealthPartners.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics. RAND Health is the developer of COMPARE (Comprehensive Assessment of Reform Efforts), a one-of-a-kind online resource that provides objective analysis about national health care reform proposals. Visit www.randcompare.org to learn more.